Scope

  • Policy Statement

  • The Policy

  • Daily Mouth Care
  • Supporting Staff Knowledge

  • Related Policies

  • Related Guidance

  • Training Statement

Policy Statement

As an organisation, we recognise the importance of good oral health including dental health and daily mouth care. We aim to encourage our service users to maintain and improve their oral hygiene and encourage timely access to dental treatment.

As an organisation, we follow NICE Guidelines NG48 and access resources such as the Oral Health Toolkit (https://www.nice.org.uk/guidance/ng48/resources) and use the latest CQC report on oral health, carrying out an oral health assessment using the tool available from the above mentioned website. This acts as a risk assessment flagging up any issues regarding oral health.

The Policy

We assess the oral care needs of all service users as soon as they start receiving our service. Service users, relevant persons and where consented to by the service user, family and friends are involved in the initial assessment. This informs the plan of care for continued oral hygiene support as consented to by the service user. The assessment includes:

  • How the service user usually manages their daily mouth care (for example, tooth brushing and type of toothbrush, removing and caring for dentures including partial dentures and identifying any support required.
  • Taking regard to any cultural or ethnic preferences concerning oral hygiene.
  • If they have dentures, including partial dentures, whether they are marked or unmarked if unmarked, we can arrange for marking, if they wish.
  • Obtaining the name and address of their dentist or any dental service they have had contact with, and where and how long ago they saw a dentist or received dental treatment.
  • Recording if there has been no contact or they do not have a dentist and help them, with their consent, find one and support the service user to make an appointment.
  • This is recorded in the care plan and the date and time of any forthcoming appointments documented.
  • Results of any dental assessments and appointments are recorded in the care plan along with any mouth or dental care requirements.
  • Reviews are carried out with the care plan reviews or if oral health needs change.

Daily Mouth Care

We ensure care staff provide service users with daily support to meet their mouth care needs and preferences, as set out in their care plan after their assessment. This includes encouraging and supporting service users to:

  • Brush their natural teeth at least twice a day with fluoride toothpaste.
  • Providing daily oral care for full or partial dentures (such as brushing, removing food debris and removing dentures overnight).
  • Use their choice of cleaning products for dentures, if possible.
  • Use their choice of a toothbrush, either manual or electric/battery powered.
  • Daily use of mouth care products prescribed by dental clinicians (e.g. this may include a high fluoride toothpaste or a prescribed mouth rinse as per their medical administration record (MAR).
  • Daily use of any over-the-counter products preferred by service users if possible, such as particular mouth rinses or kinds of toothpaste; or sugar-free gum, (gum containing xylitol helps promote dental health).
  • Observing and reporting any soreness, bleeding, pain or marks while carrying out oral hygiene.
  • If using a nebuliser/inhaler to receive mouth care before and after to reduce risk of ulceration.

Administering Mouth Care

  • Using a soft small toothbrush or foam stick, if the gingiva is damaged or likely to bleed, brush the teeth, gums and tongue to remove any debris. Brushing stimulates circulation and the gingival tissue to maintain tone.
  • Encourage the individual to rinse their mouth vigorously and spit out the contents into a small bowl or receiver; offer tissues to dry any spillages or dribbling.
  • If the individual is unable to rinse their mouth, use a rinsed toothbrush to clean the teeth and a moistened foam stick to wipe the inside of the mouth and gums; foam sticks should be used with a rotating action to ensure most of their surface is used.
  • Teeth should be flossed once every 24 hours if requested by client unless there are contraindications.

Post Procedure

  • Discard any remaining mouthwash, clean the toothbrush, and leave it to air dry.
  • Remove gloves, wash hands in soap and water, and dry.
  • Check that the individual is comfortable.
  • Record as necessary.

Equipment required for mouth care:

  • Dishes (with water).
  • Foam sticks, cotton buds, gauze swabs, tissues.
  • Non-sterile, disposable gloves
  • Face mask.
  • Fluoride toothpaste, denture paste.
  • Mouthwash or prescribed cleaning solution.
  • Lip balm (not glycerine).
  • Denture pot and an appropriate soft toothbrush or denture brush.
  • Small torch.

Example of Product

Dry mouth:

  • Mouthwash solution (e.g., Bocason 0.2%).
  • Crushed ice cubes.
  • Ice pops.
  • Vitamin C tablets (as prescribed).
  • Pineapple juice (be aware that this can increase teeth sensitivity).
  • Artificial saliva (as prescribed).

Lips: KY jelly or white soft paraffin (be aware if using oxygen or a smoker to fire hazards).
Coated tongue: effervescent Vitamin C ½ tablet, yoghurt.
Painful, inflamed mouth and fungal infections: prescribed treatments.

Supporting Staff Knowledge

Information on specific oral health needs is given by an appropriate health professional and recorded in individual care plans.
Prescribed mouth care products are as per MAR.

Training on general oral health is given to all staff, this includes:

  • Understanding the importance of service users’ oral health and the potential effect on their general health, wellbeing and dignity.
  • Understanding the potential impact of untreated dental pain or mouth infection on the behaviour, and general health and wellbeing of people who cannot articulate their pain or distress or ask for help (this includes, e.g. service users with dementia or communication difficulties).
  • Knowing how and when to reassess service users’ oral health.
  • Knowing how to deliver daily mouth care.
  • How to support people who are lacking capacity with oral health care tasks e.g. the brushing of their teeth.
  • Understanding the role of diet, alcohol, and tobacco in promoting good oral health.
  • Understanding the impact of medication or oral health.
  • Knowing how and when to report any oral health concerns for service users, and how to respond to a service user’s changing needs and circumstances (e.g. some service users, may over time lose their manual dexterity).
  • Understanding the importance of denture marking and how to arrange this for service users, with their permission. There are many advantages to denture marking most importantly the ability to identify and return lost or misplaced dentures, which is essential for our service users.
  • Ensuring care staff know how to respond if a service user does not want daily mouth care or to have their dentures removed.
  • Recognising and reporting adverse symptoms.

As an organisation, we work with and access information from local health watch teams and dental public health information to support us to meet the oral health needs of all service users, especially those with complex needs. The contact details of the individual service users’ dentist or NHS Dentist are documented in their care plan.

Related Policies

Assessment of Need and Eligibility
Care and Support Planning
Consent
Co-operating with other Providers
Dignity and Respect
Equality and Diversity
Mental Capacity Act 2005

Related Guidance

NICE Quality Statement (QS151) Oral Health in Care Homes, June 2017:
https://www.nice.org.uk/guidance/qs151

NICE Guidelines (NG48) Oral Health for Adults in Care Homes, July 2016:
https://www.nice.org.uk/guidance/ng48

CQC Fire Risk from Use of Emollient Creams:
https://www.cqc.org.uk/guidance-providers/learning-safety-incidents/issue-3-fire-risk-use-emollient-creams

Training Statement

All staff, during induction, are made aware of the organisation’s policies and procedures, all of which are used for training updates. All policies and procedures are reviewed and amended where necessary, and staff are made aware of any changes. Observations are undertaken to check skills and competencies. Various methods of training are used, including one to one, online, workbook, group meetings, and individual supervisions. External courses are sourced as required.

Date Reviewed: May 2021
Person responsible for updating this policy: Carly Fortune
Next Review Date: May 2022